Testimonial Form

ASI Staff is always asked by your colleagues for references about ASI Approved Programs. Please help us tell other AAOMS members 1) why you use a specific ASI approved program and 2) how has the ASI partner helped your OMS practice. Only entries that have completed these two qualifying questions will be eligible for the drawing to win free registration to the 95th AAOMS Annual Meeting in Orlando. Enter as often as you like with a different ASI approved program on the official entry form for each submission.

All entries must be received by April 30, 2014, and three entries will be drawn on May 1, 2014.

Winners will be notified by phone immediately after the drawing, so they can complete their plans to attend the 96th AAOMS Annual Meeting in Hawaii. Winning registrations are not transferrable to another person, but can be used by the winner for a future Annual Meeting if the winner cannot attend the Annual Meeting in Hawaii. Only AAOMS members in good standing are eligible to win.

AAOMS Member Name

Member ID

Practice Name

Phone Number

Email

Practice Address

City

State

Partner Program

Tell us why you use the program:

How has the ASI program that you chose helped your OMS practice?

By checking this box, you authorize AAOMS and ASI to use your statement in future advertisements and promotions related to the ASI Approved Programs.